Most cases of an occluded artery are due to atherosclerosis, where the formation of plaques narrow the lumen of the vessel. Surgery is considered if the occlusion is severe or if other measures like conservative management and medication fails to provide significant results as discussed under Arterial Occlusion Treatment.
Surgery may aim to :
- Physically remove the blockage (endarterectomy)
- Restore blood flow (revascularization) through the narrowing (balloon angioplasty and stent)
- Reroute blood flow around the blockage (bypass)
Surgery for Artery Blockage
An occlusion can affect any artery but is most frequently seen in the heart, neck or leg arteries.
- The procedure is conducted on medium to large arteries, like the carotid artery (neck), or femoral artery (leg).
- An endarterectomy is done under local or general anesthetic.
- The artery is accessed through an incision in the neck or leg and the atheromatous plaque is physically removed usually as one piece with a spatula.
- A shunt may be necessary to reroute blood flow around the area that is being operated upon. This is removed after the surgery is completed.
- If a portion of the artery wall is severely damage, it may removed as well and a graft will be necessary in this case.
- The entire procedure may take anywhere between 90 minutes to 3 hours.
Angioplasty and Stenting
- This procedure can be conducted on vessels of all sizes. It is the preferred surgical method for a coronary artery (heart) occlusion.
- It is done under local anesthesia.
- An angioplasty involves inserting a catheter into the affected artery and inflating the balloon at the tip to compress the atheromatous plaque. This widens the lumen of the artery.
- A metal stent is a mesh tube that is placed at the site to prevent arterial recoil (collapsing) and restenosis (narrowing). Over a few weeks, the artery will heal and new endothelial lining will grow over the stent.
- Stenting is not always required in balloon angioplasty but is routinely done for longer lasting results. New age stents can reduce complications by prevent thickening of the arterial wall (thick artery wall) and slowly release substances (drug-eluting stents / DES) to reduce future plaque formation at the site.
- The procedure may take 90 to 120 minutes for coronary artery (heart) angioplasty and stenting. For the carotid artery and peripheral arteries (leg), the procedure may be shorter in duration.
- This procedure can be conducted on vessels of all sizes and is conducted under general anesthesia.
- The aim of bypass surgery is to redirect blood flow around the blockage.
- A synthetic graft or a patient’s vein removed from another site will be used for the bypass.
- The procedure may take 3 hours or more depending on the area being operated upon.